Remote Vendor Authorization Specialist

8925 Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); Hybrid; USD 90,000 - 107,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Nursing Utilization Review professional in Massachusetts. The role focuses on processing and managing vendor authorizations, applying UM criteria, and collaborating with UM leadership to resolve issues.

The position offers a remote role with on-site meetings in Somerville, MA, a salary between $90,000 and $107,000 per year, and a benefits package with flexible options and career growth opportunities.

Qualifications

• Education Associate's Degree Nursing required or Bachelor's Degree Nursing preferred.
• Massachusetts RN license required.
• 2–3 years of utilization review experience preferred.
• 1–2 years of payer setting experience preferred.
• 1–2 years in acute care setting preferred.

Responsibilities

• Processing and managing vendor authorizations.
• Supporting vendor authorization for reporting issues.
• Maintaining authorization code management and UM criteria.
• Assisting with identification, escalation, and resolution of vendor authorization issues.
• Supporting review and resolution of UM-related letter concerns.
• Collaborating with vendors and UM leadership to address authorization processing issues.

Skills

Strong EQ

Technology aptitude

Ownership

Effective communication

Education

Associate's Degree Nursing

Bachelor's Degree Nursing

Tools

Interqual

Milliman

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Nursing Utilization Review professional in Massachusetts. The role focuses on processing and managing vendor authorizations, applying UM criteria, and collaborating with UM leadership to resolve issues.

The position offers a remote role with on-site meetings in Somerville, MA, a salary between $90,000 and $107,000 per year, and a benefits package with flexible options and career growth opportunities.